The White House Reveals A Redesigned Electronic Medical Record

More than 200 design teams participated in the Health Design Challenge, a competition to redesign patient medical records. Soon, 6 million VA patients will see the benefits.

There are 315 million "patients" in America, and only 1 million physicians. Keeping track of their histories is a gargantuan task, and many doctors have turned to the Electronic Medical Record, a computerized list of everything from allergies to addresses, to keep up. But despite being a huge improvement from paper records, the EMR is in desperate need of a graphic and technological overhaul. Doctors often don’t have time to sift through dozens of printouts before they see a patient, and even if they do, the record might not be comprehensive or up to date.

These are, essentially, design problems—at least according to Ben Blumenfeld, the force behind the Health Design Challenge, a design competition to overhaul the EMR. As the son of a doctor and the director of Designer Fund, an "angel fund of designers" that helps fledgling tech startups, Blumenfeld saw an opportunity to use design to improve the quality of patient care. "Medicine is ripe for a design revolution," he wrote last fall. "Just look at what currently passes for someone’s medical record and your brain races with all the improvements that would make this 100 times more usable and beautiful."

Working with a White House Presidential Innovation Fellow named Ryan Panchadsaram and a group of high-profile designers and doctors, Blumenfeld launched the Health Design Challenge last November. When the competition wrapped up at the end of the year, more than 230 designs had been submitted. This week, the White House and the Designer Fund unveiled the winning proposals.

So what does the future of the patient record look like? The winning design, Nightingale, was devised by Amy Guterman, Stephen Menton, Defne Civelekoglu, Kunal Bhat, Amy Seng, and Justin Rheinfrank, a team of designers and strategists who work together at Chicago consultancy gravitytank. Their scheme imagines a responsive record that can act like a dashboard, letting doctors view patients holistically and track results and prescriptions in real-time. Patients can use Nightingale as a mobile or web app, a kind of "guardian" that lets them keep track of the day’s medications or updates them with symptoms to look out for. The idea is to leverage the EMR as a tool to actually improve the quality of care, not just the clarity or visual beauty of the information. "Nightingale stood out because they defined the problem with the current medical record really well," Blumenfeld says. "It’s not just that it’s poor visual design but basically that these records have data in them that could allow us to improve our health if used correctly."

Another interesting proposal came from Studio TACK, a group of Brooklyn-based architects. Their second-place solution focused on preventing what doctors call "bounce back" patients, those regulars who keep returning to the hospital with the same problems. They proposed reorganizing the EMR by problem, rather than by chronology. This way, doctors would see the full history of Joe’s diabetes, rather than just his past two ER visits for complications. "Our health history is nonlinear," the TACK team explains. "A medical history organized solely by chronology does little to help a patient understand where they are and where they need to be." It’s a holistic approach, and historically, it’s led to some of the most major advancements in modern medicine—for example, the 19th-century anatomist Thomas Hodgkin accidentally discovered Hodgkin’s lymphoma when he began grouping specimens by type rather than chronology.

Remarkably, the Health Design Challenge’s winning proposals will soon migrate into the real world. Over the course of the next few months, a team of designers and developers led by Panchadsaram will combine aspects of the winning designs into a viable platform that will be implemented for over 6 million patients in VA hospitals. According to Blumenfeld, it may even become the standard. "This platform will then be open sourced," he added, "so that any electronic medical record company will be able to use it in their systems."

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I am a progressive young physician, currently in the midst of developing a start-up private practice. The practice is providing specialty surgical services. I am extremely frustrated about my current and ongoing experience with EMR's. Most of my ideas and innovations that would allow for easy flow and adaptation are far too advanced for the average EMR. I am severely disappointed with my fourth trial of EMR. It is time to innovate something for the patients and physicians that will allow going into private practices, easier. If you make something progressive enough, it might be able to put a link back in the patient-physician relationship. It might make it easier to regain the patient-physician relationship. At the very least, I expected to have more capability than the systems I have tried so far.

This is certainly an area that could use a re-design as such, but I do wonder if the proposed designs are over-simplified. Considering these are to be regarding by the healthcare professionals more often than the patients, is this level of detail appropriate? Is the information presented in the order which an HCP would prefer, at the depth that they desire? ...And are these images of the figure necessary, or do they simply provide visual aesthetics for something a clinician already knows?

The scope of the competition is definitely focused on the patient's experience. The proposed designs are solving the patient's problems. You bring up a good point though. It's important to notice the difference between the physicians' needs and patients' needs. Currently medical records are designed for doctors but expected to be used by both patients and doctors. I think an interesting and valuable next step would be to think through the healthcare professionals' side of the experience and bring it all together.

Its not too different here in the UK. The plethora of different (and often conflicting) requirements placed upon us when working with the NHS (National Health Service) means that design ends up being a tertiary issue.

Thankfully we have a slightly less restrictive healthcare environment in the private sector which has meant that we've been able to develop a new product (WriteUpp) for smaller practices that is design-led and functional.

I'm a physician and tech enthusiast, and I can tell you first hand that the current crop of EHR's have some of the worst software design principals of any service industry. These design ideas are a welcome change.

But to play devil's advocate, I know many EHR companies have signficant resources drawn away from usability and design to comply with boatloads of local, state, private insurance, and federal regulations.

Its no wonder that nearly every physician has a less than favorable opinion of his/her EHR vendor.

I'm a physician and tech enthusiast, and I can tell you first hand that the current crop of EHR's have some of the worst software design principals of any service industry.

These design ideas are a welcome change.

But to play devil's advocate, I know many EHR companies have signficant resources drawn away from usability and design to comply with boatloads of local, state, private insurance, and federal regulations.

Its no wonder that nearly every physician has a less than favorable opinion of his/her EHR vendor.

It is unfortunate that this just came to be a priority recently. I worked on designing both a better EOB (for a health insurance startup that tried - and failed - to compete against the big AHIP members) AND the very first versions of an EMR (for EDS). No matter how much evidence I brought to the table to urge serious attention on design of this critical information, my work was seen as an 'after-thought'. Even a few years ago when I begged to volunteer my time on some of these projects as they ramped up in the industry, I was dismissed. I have usability engineering experience, years in graphic design, an MFA, a teaching credential, and advanced certification from the American College of Sports Medicine and despite all of this, even recently my offers to help were ignored. I am glad to see that perhaps things are changing, though.

I would like to add that until and unless designers address interaction issues specific to both those working in healthcare as well as the increasing number of 'disabled' users who need equal access to such information, the best graphic design in the world will still fall short of solving the problem of communicating medical information. As an example, whatever is done here needs to work exceedingly well with voice input ..and NOT just for the disabled user but for the OB/GYN, and then some, who needs to not be using hands and arms to enter info during an exam.

I second your question though I would remind you that the information being discussed and shown in this article is largely geared towards the healthcare practitioner vs. the patient probably viewing the patient as receiving a paper version of the info recorded by the practitioner.